Propranolol kinetics in plasma from severely burned adults

Burns. 2017 Sep;43(6):1168-1174. doi: 10.1016/j.burns.2016.10.019. Epub 2017 Jun 20.

Abstract

Objectives: The aim of this study was to determine the appropriate propranolol dosing strategy for reducing heart rate in severely burned adults.

Methods: A total of 26 patients (≥18 years) with burns covering ≥30% of the total body surface area were included in this IRB-approved study. Plasma propranolol concentrations were determined in a placebo group (n=10) or following one of three dosing strategies: Q6 (n=4), Q8 (n=6), and Q24 (n=6). Blood was collected just before dosing and at regular intervals over two dosing periods with corresponding heart rate and blood pressure recordings. Statistical significance was determined by one-way ANOVA followed by the appropriate post-hoc test.

Results: Heart rate was 86±2 bpm for Q6, 93±3 bpm for Q8, and 90±4 bpm for Q24. The Q8 group had a significantly higher heart rate than the Q6 group (p=0.0001). Plasma propranolol concentrations were significantly higher in the Q6 dosing strategy than in the Q8 dosing strategy (p=0.02).

Conclusions: Heart rate can be decreased to a similar degree with Q6 and Q24 dosing strategies, with the Q8 dosing strategy being less effective. Q6 dosing is recommended to maintain reduced heart rate throughout dosing periods.

Keywords: Adult; Burns; Heart rate; β-Adrenergic receptor antagonists.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adrenergic beta-Antagonists / administration & dosage*
  • Adrenergic beta-Antagonists / pharmacokinetics
  • Adult
  • Arterial Pressure / drug effects*
  • Blood Pressure / drug effects
  • Body Surface Area
  • Burns / drug therapy*
  • Burns / physiopathology
  • Female
  • Heart Rate / drug effects*
  • Humans
  • Male
  • Middle Aged
  • Propranolol / administration & dosage*
  • Propranolol / pharmacokinetics
  • Trauma Severity Indices

Substances

  • Adrenergic beta-Antagonists
  • Propranolol